Pulmonary resection for metastatic breast cancer

Between 1982 and 1992, 60 consecutive female patients underwent pulmonary resection for metastatic breast carcinoma. Median age was 58 years (range, 21 to 81 years). The median tumor-free interval after primary breast cancer operation was 2.2 years (range, 7 days to 20.6 years). Thirty-one patients (51.6%) had solitary pulmonary metastases. Forty patients (66.7%) had complete pulmonary resection, which consisted of wedge excision in 33, lobectomy in 6, and pneumonectomy in 1. The remaining 20 patients had incomplete resection, which consisted of wedge excision in all. Altogether, 8 patients (13.3%) had development of postoperative complications, which included pneumothorax, prolonged air leak, pulmonary embolism, retained secretions requiring bronchoscopy, atrial fibrillation, and chest tube site infection. There was one operative death (1.7%). Follow-up was complete in all patients and ranged from 23 days to 10.7 years (median, 3.5 years). Recurrence developed in 32 of the 39 survivors (82.1%) who had complete resection. Median disease-free interval after lung resection was 1.6 years (range, 23 days to 9.3 years). Overall 5-year survival was 37.8% (95% confidence interval, 25.1% to 50.5%). The 40 patients who had complete resection had a 5-year survival of 35.6% (95% confidence interval, 20.4% to 50.8%) as compared with 42.1% (95% confidence interval, 19.0% to 65.3%) for the 20 patients with incomplete resection (p = not significant). Although pulmonary resection is safe, we could not demonstrate improved survival after complete pulmonary resection of metastatic breast carcinoma in this highly selected group of patients.